Researchers say there’s an opportunity to close the ‘failure to rescue’ gap between men and women after cardiovascular procedures.
A recent study led by researchers at the University of Michigan reveals troubling disparities in postoperative outcomes between men and women following high-risk cardiovascular surgeries.
Despite comparable rates of complications, women exhibit a significantly higher mortality rate from these complications, underscoring a critical issue within the U.S. healthcare system.
The study, published in JAMA Surgery, analysed over 850,000 cases involving Medicare beneficiaries who underwent high-risk procedures such as heart bypass, aortic aneurysm repair and mitral and aortic valve repairs from 2015 to 2020.
While both sexes experienced complication rates of approximately 15%, women faced a failure to rescue rate of 10.7%, compared to 8.6% for men.
Dr Catherine M. Wagner, the study’s first author and an integrated thoracic surgery resident at U-M Health, emphasises improved recognition and response to complications in female patients.
She said: ‘We are failing to rescue women after high-risk surgery even though the rate of postoperative complications is similar to men. There needs to be improved recognition and response to these complications if we are to narrow the sex disparities after high-risk surgery.’
The research team found this failure-to-rescue pattern consistent across various high-risk procedures, with the most common complications being kidney failure, pneumonia and lung failure.
Interestingly, the quality of the hospitals where surgeries were performed did not impact the disparity in failure rates between sexes.
Women were more likely to have their surgeries at hospitals that typically handle a higher volume of high-risk cases.
Co-author Dr Gorav Ailawadi, chair of cardiac surgery at U-M Health, pointed out that while high-risk procedures inherently carry a greater risk for complications, successful management is crucial for positive patient outcomes.
He noted that female patients had a lower rate of reoperations than males, which may not indicate fewer complications but rather a failure to address existing issues appropriately.
Historically, women have been more likely to experience adverse outcomes after cardiovascular surgeries, a disparity often attributed to older age, higher comorbidities and anatomical differences that complicate surgical procedures.
Co-author Dr Andrew Ibrahim, associate professor of surgery at U-M Medical School, said that previous studies have highlighted that symptoms of cardiovascular diseases are often overlooked or not taken seriously in female patients.
‘In our study, after accounting for patient comorbidities and risk factors, we found that men and women had similar rates and types of complications; however, women remained more likely to die from those complications,’ he said.
The findings underscore the urgent need for targeted interventions aimed at improving early recognition of complications in female patients.
Dr Ibrahim added: ‘We must focus on what happens after a complication occurs. There’s an opportunity to improve early recognition when a female patient is experiencing complications before they escalate to a point where we cannot rescue them.’
In June 2016, the National Institutes of Health mandated that sex as a biological variable be considered in research design and analysis in response to the historical underrepresentation of women in medical research.
Dr Wagner advocates for a dual approach – addressing systemic disparities in healthcare and prioritising sex differences in biomedical research to improve patient outcomes.
